Assessment of Psychosocial Contributions to Disability

Abstract

Disability has traditionally been defined in biomedical terms and closely associated with objective physical impairment. More recent conceptualizations though, hold that a comprehensive evaluation of disability requires not only the assessment of objective physical impairment, but also an assessment of the psychosocial context in which the disability occurs. Some psychosocial risk factors, such as socioeconomic status, are objective in nature. In contrast, other psychosocial risk factors, such as depression, are determined by the report of subjective states. To assess these subjective states, standardized psychological tests can play a valuable role. The defining characteristics of standardized psychological tests are discussed, as are their uses. Commonly used psychological tests are reviewed. Practical questions are also addressed, such as when to administer psychological tests, what psychosocial risk factors need to be assessed, what tests to use, methods of quantifying the level of psychosocial risk, and the detection of faking.

Appendix: Psychometric Assessment Tools

The tests listed below are for informational purposes only, and this is not an exhaustive list. The final decision about which tests to use must be left to the evaluator. Within each section, tests are listed in alphabetical order.

Assessment Task	Test	Notesa		Description
Brief Assessments of Emotion	These tests are useful when the assessment of a patient’s emotional status is desired.
	BDI II	S J B G		Beck Depression Inventory II: Well-researched measure of depression, widely used clinically and in research. A brief measure that assesses a broad range of cognitive, affective, and physical depressive symptoms. 21 items, 1 scale, no validity measures. 5 min, hand scoring, computerized scoring and report
	BSI 18	S J B G N		Brief Symptom Inventory 18: Brief measure of depression, anxiety, and somatization. Community and cancer patient norms. 18 items, 3 scales, no validity measures, computerized scoring and report, and hand scoring. 2–3 min
	CES-D	J G		Center for Epidemiological Studies Depression Scale: Brief measure of depression that has been widely used in research. Assesses depression without reliance on physical symptoms, reducing the risk of false positive findings. No norms. 20 items, 1 scale, no validity measures, 3 min, hand scoring
	HDI	J G		Hamilton Depression Inventory: Brief measure of depression, widely used in research. Assesses a broad range of cognitive, affective, and physical depressive symptoms. Uses community norms. 23 items, 1 scale, fifth grade reading level, no validity measures, 5 min. A variation of this is the Hamilton Rating Scale, which is a 17 or 21 item measure filled out by the professional
	STAI	S J B G N		State-Trait Anxiety Inventory: Well-researched measure of both anxious states and anxious tendencies. A brief measure that assesses a broad range of cognitive, affective, and physical anxiety symptoms. Community norms. 40 items, 2 scales, no validity measures, 8–10 min
	Zung	J G		Zung Depression Scale: Brief measure of depression that has been widely used in research. A brief measure that assesses a broad range of cognitive, affective, and physical depressive symptoms. Uses cutoff scores, not norms. 20 items, 1 scale, no validity measures, 5 min, hand scoring
Brief Assessment of Pain and Functioning	These tests are useful when the assessment of a patient’s ability to function is desired.
	BPI-SF	S J G		Brief Pain Inventory Short Form: Assesses pain, pain variation, and pain distribution through drawing. Also assesses degree to which pain interferes with functioning. Used in pain research, no norms. 20 items, multiple measures, no validity measures, 4–6 min
	Oswestry	J G		Oswestry Low Back Pain Disability Questionnaire: Commonly used measure of functioning in research studies is known to be sensitive to assess change. Original version has been shown to be an effective research outcome measure, multiple modified versions, and no norms. 20 Items, 1 scale, no validity measures, 4–5 min
	PDQ	J G		Pain Disability Questionnaire: Brief tool that appears to be a sensitive measure of disability associated with pain. 15 items, 1 scale, no norms, no validity measures, 3–4 min
	Roland and Morris	J G		Roland and Morris Disability Questionnaire: Commonly used measure of functioning in research studies is known to be able to assess change in functioning. Original version is a frequently used research outcome measure.
				24 items, 1 scale, no norms, no validity measures, 4–5 min
				Translated into Arabic, Chinese, Croatian, Czech, Danish, Dutch, English, Flemish, French, German, Greek, Hindi, Hungarian, Iranian, Italian, Japanese, Kannada, Korean, Marathi, Norwegian, Polish, Portuguese, Romanian, Russian, Spanish, Swedish, Tamil, Telugu, Thai, Tunisian, Turkish, and Urdu, 3–4 min
	SF 36 – V2	S J G N		Short Form 36 Questionnaire Version 2: Overall assessments of physical and mental health, Function scale is the strongest and it assesses subjective reports of impairment. Has scoring software. Original SF 36 is less well standardized. SF 36-V2 has an improved administration format, norms, and standardized scores. 36 items, 8 scales, no validity measures, 6–8 min
				Translated into English, Spanish, German, French, Chinese, Japanese, and for persons from the following countries: Armenia, Bangladesh, Brazil, Bulgaria, Cambodia, Croatia, Czech Republic, Finland, Greece, Hungary, Iceland, Israel, Korea, Latvia, Lithuania, Poland, Portugal, Romania, Russia, Singapore, Slovak Republic, Tanzania, Turkey, Wales (UK), and Vietnam
	MPQ-SF	J B G		McGill Pain Questionnaire Short Form: Assesses sensory, affective, and evaluative dimensions through the use of verbal descriptors of pain experience as opposed to pure pain intensity, no norms. 15 items, 2 scales, no norms, no validity measures, 3–5 min
				Translated into Amharic (Ethiopian), Arabic, Chinese, Czech, Danish, Dutch, English, Finnish, Flemish, French, German, Greek, Hungarian, Italian, Japanese, Norwegian, Polish, Portuguese, Slovak, Spanish, and Swedish.
	NRS	J G		Pain Numerical Rating Scale: Ubiquitous pain rating scale is recommended by JCAHO. Extremely easy to use, usually administered verbally. Unstandardized test, with unknown number of variations. No agreement on scaling (e.g., 0–10 vs. 1–100), location (e.g., rating whole body vs. one body part) or time (e.g., right now vs. typical). No norms. <1 min
	VAS	J G		Pain Visual Analog Scale: Sensitive measure of pain used extensively in research. Unstandardized test, with unknown number of variations. No agreement on graphic format of test (e.g., length of line; does the line have numbers on it), location (e.g., rating whole body vs. one body part) or time (e.g., right now vs. typical). No norms. <1 min
	Intermediate Length Assessments of Pain and Disability	Intermediate Length Assessments of Pain and Disability
	BBHI 2	S J B G N		Brief Battery for Health Improvement 2: Assesses depression, anxiety, somatization, pain and function. Also has validity measures for minimizing, exaggerating, and random responding. Pain measures include pain intensity, distribution, and tolerability. Normed on both community sample and a rehabilitation sample. Computer scored. Has Spanish version. 63 items, 6 scales, 15 critical items, 1 validity measure, fifth grade reading level, 8–10 min
	BPI	S J G		Brief Pain Inventory-Long Form: Assesses pain, pain variation, and pain distribution through drawing. Also assesses degree to which pain interferes with functioning. Includes demographic and medication short answer questions. 15–25 min
	BSI		S J B G N	Brief Symptom Inventory: Brief assessment of a broad range of psychopathology, including somatization, depression, anxiety, hostility obsessive-compulsiveness, paranoid ideation, and psychoticism. 53 items, 12 scales, no validity measures, computerized scoring and report, 7–8 min
	P3		S J B G N	Pain Patient Profile: Measure of depression, anxiety and somatization with chronic pain patient and community norm groups. Validity measure checks for random or bizarre responding. Has Spanish version. 44 items, 3 scales, one validity measure, computerized scoring and report, 12–15 min
Comprehensive Assessment of Psychopathology	These tests are useful for the comprehensive assessment of psychopathology and were designed primarily for psychiatric patients.
	MCMI III		S J B G N	Millon Clinical Multiaxial Inventory III: Scales keyed to the DSM IV. Also has scales for DSM IV diagnoses of affective and psychotic disorders, and for each form of personality disorder. Base rate scoring attempts to adjust test findings to approximate the actual base rates of psychological disorders in the psychiatric population. Has Spanish version. 175 items, 25 scales, three validity measures, critical items, computerized scoring and report, eighth grade reading level, 25–30 min
	MMPI-2		S J B G N	Minnesota Multiphasic Personality Inventory-2: Most researched psychological test, with well-established strengths and weaknesses. Over 100 scales and indices to assess a wide range of psychological conditions. Extensive validity assessment is valuable to assess conscious or unconscious exaggeration of reports. Has Spanish version. 567 items, 100+ scales and indices, critical items, computerized scoring and report, hand scoring, sixth grade reading level, 70–90 min
	MMPI-2-RF		S J B G N	Minnesota Multiphasic Personality Inventory 2 – Revised Form: New version of MMPI 2 that has undergone radical revision to correct perceived MMPI 2 deficiencies. Extensive validity assessment is valuable to assess conscious or unconscious exaggeration of reports. May be stronger at psychiatric assessment, but some studies found it to be less capable when assessing somatoform disorders. (Butcher et al, 2006; Thomas & Youngjohn, 2009) 338 items, 50 scales including 8 validity scales, critical items, fifth grade reading level 45–50 min
	PAI		S J B G N	Personality Assessment Inventory: A comprehensive personality test that is significantly shorter than the MMPI 2. Assesses a broad cross-section of affective, characterological, and psychotic conditions. Multiple validity measures. 340 items, 22 scales, including 4 validity scales, critical items, fourth grade reading level, 50–60 min
Comprehensive Assessment of Medical Patients	These are psychological tests designed specifically for the comprehensive assessment of medical patients.
	BHI 2	S J B G N		Battery for Health Improvement 2: Assesses broad range of psychological symptoms, characterological risks, social conflicts, coping, and physical symptoms, such as pain and disability complaints. Pain measures include pain intensity, pain distribution, pain intolerance, and dysfunctional pain cognitions. Normed on both community sample and a rehabilitation sample, plus has eight other reference groups, including chronic pain, head injury, and fake bad. Has three validity measures for minimizing, exaggerating and random responding. Has Spanish version. 217 items, 18 scales, including 3 validity measures, 30 content areas, 25 critical items, computerized scoring and report. Sixth grade reading level, 30–35 min
	MBMD	S J B G N		Millon Behavioral Medicine Diagnostic: Assesses broad range of psychiatric and problematic behavioral comorbidities that may affect health management and compliance. Offers analysis of health habits, psychiatric indicators, coping styles, and stress moderators. Three validity scales were developed to detect exaggerating or minimizing of symptoms. Two patient norm groups, bariatric and chronic illness (heart disease, diabetes, HIV, neurological and others). Has Spanish version. 165 Items, 38 scales, 3 validity measures, computerized scoring, sixth grade reading level, 20–30 min
Assessment of malingering	These tests are used solely to detect malingering.
	CARB	S J B G N		Computerized Assessment of Response Bias: Used to assess whether an individual is falsifying symptoms of memory impairment. No norms
	Hare	S J B G N		Hare Psychopathy Checklist – Revised: The assessment can be used to help assess the degree to which an individual exhibits severe antisocial traits, in the form of a prototypical violent psychopath. May be useful if assessing patients who are making threats
	SIMS	S J B G N		Structured Inventory of Malingered Symptomatology: Used for both malingered psychopathology and neuropsychological symptoms
	TOMM	S J B G N		Test of Memory Malingering: Used to assess whether an individual is falsifying symptoms of memory impairment. No norms
	VIP	S J B G N		Validity Indicator Profile: Employs independent verbal and nonverbal subtests to assess the validity of the patient’s reports. Computer scored. No norms
	WMT	S J B G N		Word Memory Test: Used to assess whether an individual is falsifying symptoms of verbal memory impairment. No norms
Assessment of Cognitive Ability	These tests are measures of intelligence, memory, and cognitive processing ability.
	GAMA	S J B G N		Global Assessment of Mental Ability: Culture-free measure of general intellectual ability. Based on the scores on four subtest scales: Matching, Analogies, Sequences, and Construction. Community norms. 25 min timed test
	RBANS	S J B G N		Repeatable Battery for the Assessment of Neuropsychological Status: Measures neuropsychological status and cognitive decline in individuals who have experienced stroke, head injury, dementia, or neurological injury or disease. Community norms. Less than 30 min
	WASI	S J B G N		Wechsler Abbreviated Scale of Intelligence: An abbreviated measurement of adult intelligence in short and very short forms. 15 min for 2 subtests IQ. 30 min for 4 subtest IQ
	WAIS-IV	S J B G N		Wechsler Adult Intelligence Scale – IV: Common measure of adult intelligence assesses cognitive strengths and weaknesses. WAIS-IV and WMS-IV are the only conormed ability-memory instruments. 60–90 min
	WMS-IV	S J B G N		Wechsler Memory Scale – IV: Measures visual and auditory memory, immediate versus delayed memory, and free recall versus cued recall as well as recognition. Normed on older adolescents and adults. 30–35 min
	WRAT-4	S J B G N		Wide Range Achievement Test – 4: Achievement test assesses basic academic skills of reading, spelling, and math, with norms to age 94. The test has been validated against multiple other cognitive psychological tests. 35–45 min

1. ^aNotes: S Standardized test materials; N Norms; J Peer reviewed journal publications; B Reviewed by Buros Institute; G Noted in Treatment Guidelines